Primary Superficial High-Grade Bladder Cancer

Risk, Recurrence and Progression

  • Diogo Pereira Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Francisco Botelho Departamento de Urologia, Hospital de Braga, Braga, Portugal; Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Pública, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
  • Carlos Silva Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Departamento de Urologia, Hospital de São João, Porto, Portugal
  • João Silva Faculdade de Medicina da Universidade do Porto, Porto, Portugal; Departamento de Urologia, Hospital de São João, Porto, Portugal
Keywords: Carcinoma In Situ, BCG Vaccine, Disease Progression, Prognosis, Neoplasm Recurrence, Local, Risk Factors, Urinary Bladder Neoplasms


Purpose: We aimed to characterize the population with primary high-grade non muscle invasive bladder cancer followed in a Portuguese Central Hospital and simultaneously identify recurrence and progression rates and associated risk factors.

Material and Methods: The analysis included 79 patients who were diagnosed with primary high-grade non muscle invasive bladder cancer on first transurethral resection between 2006 and 2010. Several variables were statistically analyzed to evaluate their prognostic importance.

Results: With a median follow-up of 54 months, 19 patients (24.1%) recurred, four (5.1%) progressed to muscle-invasive disease and two (2.5%) underwent radical cystectomy. The most important prognostic factor of recurrence was the duration of intravesical bacillus Calmette-Guérin (BCG) treatment while the presence of carcinoma in situ was the most important prognostic factor of progression. Residual disease on second-look transurethral resection showed to reduce the recurrence-free-survival.

Conclusion: In our population, recurrence and progression rates were much lower than those described in other studies. Residual disease on second-look transurethral resection is associated with decreased recurrence-free-survival while the presence of carcinoma in situ is related with higher risk of progression. The duration of treatment with BCG seems to reduce the risk of recurrence.


Download data is not yet available.


1. Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA
Cancer J Clin. 2005;55:74-108.

2. Burger M, Catto JW, Dalbagni G, Grossman HB, Herr H, Karakiewicz P,
et al. Epidemiology and risk factors of urothelial bladder cancer. Eur Urol.

3. Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BW, Comperat E,
et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the
bladder: update 2013. Eur Urol. 2013;64:639-53.

4. Kirkali Z, Chan T, Manoharan M, Algaba F, Busch C, Cheng L, et al. Bladder
cancer: epidemiology, staging and grading, and diagnosis. Urology.
2005;66(6 Suppl 1):4-34.

5. Dutta SC, Smith JA, Jr., Shappell SB, Coffey CS, Chang SS, Cookson MS.
Clinical under staging of high risk nonmuscle invasive urothelial carcinoma
treated with radical cystectomy. J Urol. 2001;166:490-3.

6. Herr HW. The value of a second transurethral resection in evaluating patients
with bladder tumors. J Urol. 1999;162:74-6.

7. Nieder AM, Brausi M, Lamm D, O’Donnell M, Tomita K, Woo H, et al. Management
of stage T1 tumors of the bladder: International Consensus Panel.
Urology. 2005;66:108-25.

8. Cookson MS, Herr HW, Zhang Z-F, Soloway S, Sogani PC, Fair WR. The
Treated Natural History of High Risk Superficial Bladder Cancer: 15-year
Outcome. J Urol. 1997;158:62-7.

9. Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C,
Denis L, et al. Predicting recurrence and progression in individual patients
with stage Ta T1 bladder cancer using EORTC risk tables: a combined
analysis of 2596 patients from seven EORTC trials. Eur Urol. 2006;49:466-
5; discussion 475-7.

10. Fernandez-Gomez J, Madero R, Solsona E, Unda M, Martinez-Pineiro L,
Gonzalez M, et al. Predicting nonmuscle invasive bladder cancer recurrence
and progression in patients treated with bacillus Calmette-Guerin:
the CUETO scoring model. J Urol. 2009;182:2195-203.

11. Gontero P, Sylvester R, Pisano F, Joniau S, Vander Eeckt K, Serretta V,
et al. Prognostic Factors and Risk Groups in T1G3 Non-muscle-invasive
bladder cancer patients initially treated with bacillus Calmette-Guerin:
results of a retrospective multicenter study of 2451 patients. Eur Urol.

12. Kulkarni GS, Hakenberg OW, Gschwend JE, Thalmann G, Kassouf W,
Kamat A, et al. An updated critical analysis of the treatment strategy for
newly diagnosed high-grade T1 (previously T1G3) bladder cancer. Eur
Urol. 2010;57:60-70.

13. Hautmann RE, Volkmer BG, Gust K. Quantification of the survival benefit
of early versus deferred cystectomy in high-risk non-muscle invasive bladder
cancer (T1 G3). World J Urol. 2009;27:347-51.

14. Schulze M, Stotz N, Rassweiler J. Retrospective analysis of transurethral
resection, second-look resection, and long-term chemo-metaphylaxis for
superficial bladder cancer: indications and efficacy of a differentiated
approach. J Endourol. 2007;21:1533-41.

15. Babjuk M. Transurethral resection of non-muscle-invasive bladder cancer.
Eur Urol. 2009;8:542-548.

16. Richards KA, Smith ND, Steinberg GD. The importance of transurethral
resection of bladder tumor in the management of nonmuscle invasive
bladder cancer: a systematic review of novel technologies. J Urol.

17. Herr HW. Restaging transurethral resection of high risk superficial bladder
cancer improves the initial response to bacillus Calmette-Guerin therapy.
J Urol. 2005;174:2134-7.

18. Herr HW, Donat SM, Dalbagni G. Can restaging transurethral resection
of T1 bladder cancer select patients for immediate cystectomy? J Urol.
2007;177:75-9; discussion 79.

19. Palou J, Sylvester RJ, Faba OR, Parada R, Peña JA, Algaba F, et al. Female
gender and carcinoma in situ in the prostatic urethra are prognostic
factors for recurrence, progression, and disease-specific mortality in
T1G3 Bladder cancer patients treated with bacillus Calmette-Guérin. Eur
Urol. 2012;62:118-25.

20. Orsola A, Cecchini L, Raventos CX, Trilla E, Planas J, Landolfi S, et al.
Risk factors for positive findings in patients with high-grade T1 bladder
cancer treated with transurethral resection of bladder tumour (TUR) and
bacille Calmette-Guerin therapy and the decision for a repeat TUR. BJU
Int. 2010;105:202-7.

21. Herr HW, Dalbagni G, Donat SM. Bacillus Calmette-Guérin without maintenance
therapy for high-risk non–muscle-invasive bladder cancer. Eur
Urol. 2011;60:32-36.

22. Segal R, Yafi FA, Brimo F, Tanguay S, Aprikian A, Kassouf W. Prognostic
factors and outcome in patients with T1 high-grade bladder cancer: can
we identify patients for early cystectomy? BJU Int. 2012;109:1026-30.

23. Sylvester RJ. Natural history, recurrence, and progression in superficial
bladder cancer. SciWorldJ. 2006;6:2617-25.

24. Fernandez-Gomez J, Solsona E, Unda M, Martinez-Piñeiro L, Gonzalez
M, Hernandez R, et al. Prognostic factors in patients with non–muscle-
-invasive bladder cancer treated with bacillus Calmette-Guérin: multivariate
analysis of data from four randomized CUETO Trials. Eur Urol.

25. Martin-Doyle W, Leow JJ, Orsola A, Chang SL, Bellmunt J. Improving selection
criteria for early cystectomy in high-grade T1 Bladder cancer: a
meta-analysis of 15,215 patients. J Clin Oncol. 2015;33:643-50.

26. Orsola A, Trias I, Raventos CX, Espanol I, Cecchini L, Bucar S, et al. Initial
high-grade T1 urothelial cell carcinoma: feasibility and prognostic significance
of lamina propria invasion microstaging (T1a/b/c) in BCG-treated
and BCG-non-treated patients. Eur Urol. 2005;48:231-8; discussion 238.